The Japanese Epidemiologic Study for Perioperative Anaphylaxis, a prospective nationwide study: clinical signs, severity, and therapeutic agents
The Japanese Epidemiologic Study for Perioperative Anaphylaxis, a prospective nationwide study: clinical signs, severity, and therapeutic agents
复制标题
日本围手术期过敏反应流行病学研究，一项全国性前瞻性研究：临床症状、严重程度和治疗药物
DOI：
10.1016/j.bja.2023.02.023
复制
发表时间：
2023
影响因子：
9.8
通讯作者：
Orihara Masaki et al.
中科院分区：
文献类型：
--
作者：
Suigiyama Yuki;Takazawa Tomonori;Watanabe Natsuko;Bito Kiyoko;Fujiyoshi Tetsuhiro;Hamaguchi Shinsuke;Haraguchi Takashi;Horiuchi Tatsuo;Kamiya Yoshinori;Maruyama Noboru;Masumo Hitoshi;Nakazawa Harumasa;Nagumo Kazuhiro;Orihara Masaki et al.
背景围手术期过敏反应的诊断是困难的，因为它的非特异性和可变的体征和症状。用于治疗过敏反应的治疗药物和麻醉师的反应也因病例而异，这可能会影响结果;然而，只有少数研究关注这些因素。方法围手术期过敏反应的前瞻性研究，日本围手术期过敏反应流行病学研究的一部分，研究了围手术期过敏反应的临床体征，其严重程度，治疗药物，肾上腺素给药，以及麻醉师在围手术期过敏反应病例中的反应，以评估趋势和变异性。休克指数用于评估心血管崩溃的严重程度。结果在本研究中分析的43例患者中，心血管体征（88.4%）是最常见的，其次是皮肤（81.4%）和呼吸体征（60.5%）。临床过程中体征的存在增加。从第一个症状到诊断过敏反应的中位时间为10（5.0-17.8）分钟。肾上腺素使用率分别为30.2%（未使用），48.8%（静脉注射），和20.9%（i.m.）。从过敏反应诊断到肾上腺素给药的中位时间为7分钟（四分位数间距：1.5-8.0）。69.8%的病例分别使用抗组胺药和皮质类固醇。接受静脉注射肾上腺素的患者的最差休克指数（2.77 [0.90]平均值[标准差]）高于未使用肾上腺素的病例（1.35 [0.41]）和静脉注射肾上腺素的病例（1.35 [0.90]平均值[标准差]）。肾上腺素例数（1.89 [0.77]（P<0.001）。结论围手术期过敏反应的临床体征和治疗是可变的，关于肾上腺素给药的选择是基于症状的严重程度。
BackgroundDiagnosis of perioperative anaphylaxis is difficult because of its non-specific and variable signs and symptoms. Therapeutic agents used to treat anaphylaxis and anaesthesiologist responses also vary depending on the case, which might affect outcomes; however, only a few studies have focused on these factors.MethodsThis prospective study of perioperative anaphylaxis, a part of the Japanese Epidemiologic Study for Perioperative Anaphylaxis, investigated the clinical signs, its severity, therapeutic drugs, epinephrine administration, and anaesthesiologist responses in cases of perioperative anaphylaxis to assess trends and variability. Shock index was used to assess severity of cardiovascular collapse.ResultsIn 43 patients analysed in this study, cardiovascular signs (88.4%) were the most frequent, followed by skin (81.4%) and respiratory signs (60.5%). The presence of signs increased during the clinical course. The median time from the first signs to diagnosis of anaphylaxis was 10 (5.0–17.8) min. The rates of epinephrine use were 30.2% (unused), 48.8% (i.v.), and 20.9% (i.m.). The median time from diagnosis of anaphylaxis to epinephrine administration was 7 (inter-quartile range: 1.5–8.0) min. Antihistamines and corticosteroids were each used in 69.8% of cases. The worst shock index was higher in patients who received i.v. epinephrine (2.77 [0.90] mean [standard deviation]) than in both no epinephrine use cases (1.35 [0.41]) and i.m. epinephrine cases (1.89 [0.77] (P<0.001]).ConclusionsThe clinical signs and treatments of perioperative anaphylaxis are variable, and the choice regarding epinephrine administration is based on symptom severity.Clinical trial registrationUMIN000035350.